Differential Diagnosis and Management of Respiratory ... - FANNP
Differential Diagnosis and Management of Respiratory ... - FANNP
Differential Diagnosis and Management of Respiratory ... - FANNP
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<strong>FANNP</strong> 23RD NATIONAL NNP SYMPOSIUM: CLINICAL UPDATE AND REVIEW<br />
Pulmonary Interstitual Emphysema:<br />
(PIE)<br />
PIE <strong>Management</strong><br />
• Single or multiple circular<br />
radiolucencies with well-<br />
demarcated walls.<br />
• May be localized or<br />
diffuse.<br />
•Prevent! Prevent! Prevent!<br />
•Minimize PIP, shorten Inspiratory<br />
Time, Reduce MAP.<br />
•Positional therapy with affected<br />
side down if unilateral.<br />
•HFJV or HFOV<br />
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Tension Pneumothorax<br />
Pneumopericardium<br />
• Always symptomatic with sudden<br />
deterioration, especially if on PPV.<br />
• May become hypotensive with<br />
bradycardia as the high<br />
intrathoracic pressure impedes<br />
cardiac output.<br />
• Prompt relief by thoracentesis or<br />
thoracostomy is indicated.<br />
• Usually occurs in association<br />
with one or more other air<br />
leaks.<br />
• Rare in the non-ventilated<br />
infant.<br />
• Muffled heart sounds.<br />
• Halo completely surrounds the<br />
heart - including the inferior<br />
surface.<br />
• Symptoms mostly based on<br />
degree <strong>of</strong> tamponade.<br />
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Pneumopericardium<br />
<strong>Management</strong><br />
• Must acutely manage symptoms.<br />
• May resolve spontaneously with support <strong>of</strong> the<br />
infant’s symptoms.<br />
• Treat with pericardiocentesis or pericardial tube<br />
placement - 79% survival.<br />
• Conservative management - 32% survival.<br />
• 53% incidence <strong>of</strong> re-accumulation with pericardial<br />
taps alone.<br />
Reppert, S.M., Ment, L.R., & Todres, I D., (1977). The treatment <strong>of</strong><br />
pneumopericardium in the newborn, J. Pediatrics, 90:115.<br />
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B07: MANAGEMENT OF RESPIRATORY DISTRESS Page 12 <strong>of</strong> 23